Rheumatic Heart Disease and Contraception Use in Ethiopia: A Cross-Sectional Study

Background Women of reproductive age with rheumatic heart disease (RHD) face a high risk of cardiovascular complications during pregnancy. Consequently, preconception counseling and contraception are routinely recommended for all women of reproductive age. In Ethiopia, there are no data available regarding contraception coverage among women with RHD. Objectives The aims of this study were to examine the prevalence of contraceptive use, investigate the most common methods, and identify factors influencing contraception use among reproductive-age women with RHD in Ethiopia. Methodology The study included patients who were followed at a tertiary hospital between January 1, 2017, and October 30, 2018. A total of 359 women aged 15 to 49 years with RHD were randomly selected and evaluated using standardized questionnaires and chart reviews. Chi-square and logistic regression analyses were utilized to measure associations. A p-value of ≤0.05 was deemed significant, with a 95% confidence interval. Results The mean age was 30.96 ±7.84 years. Of the patients, 219 (61%) were unemployed, and only 92 (25%) had higher education. Of the 241 (67%) who had severe RHD, 205 (57%) had combined valve lesions, 76 (21.2%) had isolated mitral stenosis, and 62 (17.3%) had isolated mitral regurgitation. Of the total of 359 patients, 300 (83.6%) had symptoms; 241 (67.1%) were class IV per the modified World Health Organization (mWHO) cardiovascular risk assessment, and the rest, 118 (32.9%), were class III. A total of 139 (38.9%) and 112 (31.3%) were on warfarin and angiotensin-converting enzyme inhibitors, respectively. However, only 149 (41.5%) were on contraceptives, and among non-users, 226 (63%) reported no counseling. Injectables were the most used contraceptive, followed by intrauterine devices and oral pills. Marital status (OR: 3.26, 95% CI: 2.03-5.22, P < 0.001) and employment (OR: 3.82, 95% CI: 1.58-9.24, P = 0.003) were the only two statistically significant factors associated with contraception use. Conclusion Contraception use was low among women with RHD in Ethiopia. Patients with contraindications for pregnancy were not provided with adequate counseling and contraception. Additionally, those who were using contraception were on ineffective methods. Further action is needed to improve contraception use among women with RHD.